1. Field of the Invention
The present invention relates to methods of retaining gastric tubes and more particularly to methods of securing a gastric tube relative to an intubated patient.
2. Description of the Related Art
A gastric tube, commonly called a Salem tube, is a hollow plastic tube usually made of polyvinylchloride (PVC), that is inserted through the nose or mouth, down the back of the throat, through the esophagus and into the stomach. Gastric tubes are commonly used in the treatment of patients in order to provide nutrition and/or for stomach emptying. Generally, gastric tubes inserted into the stomach are made stiff to resist collapsing when suction is applied. Gastric emptying is effected to prevent vomiting or to monitor how well a patient is tolerating being fed into the stomach. If the patient is not tolerating being fed into the stomach, the patient may tolerate being fed into the duodenum (past the stomach) via a longer duodenal tube. This duodenal feeding tube is made smaller, thinner and softer than a gastric tube because it is used just for feeding and not for stomach emptying. The duodenal feeding tube is weighted on its end and has a guide wire to aid the clinician in inserting this tube into the duodenum.
Gastric tubes are available in six common sizes: 8, 10, 12, 14, 16, and 18 French (roughly 0.08 to 0.24 inches in outer diameter). The choice in size to use for a patient may relate to the size of the patient or the primary purpose of the gastric tube. Generally, for unconscious patients, bigger tubes are easier to insert, as they are more rigid and therefore resist curling in the oropharynx. Larger tubes also have less resistance and promote better flow and have less chance of obstructing.
The securing of gastric tubes to critically ill patients has been a problem for many years. Past and current devices used to secure gastric tubes usually comprise an adhesive material. Tape is widely used because it is inexpensive and readily available. Different types of tape can be used and it is usually wrapped around the gastric tube and then stuck to the patient""s nose or face.
However, tape may come loose or may cause pressure sores by holding the gastric tube too tightly to the nostril and the patient can pull his/her gastric tube out fairly easily if it is only taped in place. Tape provides an inconsistent hold, depending on the type of tape used and the technique for applying it. Also, the presence of moisture and/or oil from the patient""s skin can cause tape to loosen with time. As a backup, some hospitals tape the gastric tube directly to the tracheal tube, if the patient is intubated, or use a safety pin with tape to secure the gastric tube to the patient""s gown, providing additional security.
When using gloves, tape is difficult to handle, requiring the clinician to expose his or her hands to potentially infectious body fluids. Overall, tape is difficult to work with, takes longer to apply, and gives the patient an alarming appearance. Also, allergic reactions, skin irritations and nasal tissue necrosis have been reported from the use of tape. Replacing gastric tubes, and especially duodenal feeding tubes, is time consuming and costly, making it important to use a secure and reliable device.
If the gastric tube is taped to the tracheal tube, however, reference marks along the tracheal tube are obscured and repositioning is difficult.
Some tracheal tubes are accidentally cut too short prior to insertion, so that the hub of the tracheal tube is almost level with the patient""s face. In this case, the gastric tube is usually just taped to the face of the patient.
According to the present invention, a method of retaining a gastric tube, before or after insertion of a tracheal tube into a patient, comprises the steps of attaching a gastric tube retainer to an end portion of the tracheal tube and connecting the end portion of the tracheal tube to a ventilating circuit so as to secure the gastric tube retainer on the end portion of the tracheal tube, inserting the gastric tube into the patient, and engaging the gastric tube in the gastric tube retainer to thereby secure the gastric tube in position relative to the tracheal tube.
Preferably, the gastric tube retainer is made of sheet material and the gastric tube is engaged in the gastric tube retainer, before or after the attachment of the gastric tube retainer to the tracheal tube, by spreading apart portions of the gastric tube retainer along a slit, and sliding the gastric tube into the gastric tube retainer along the slit to a gastric tube opening having a diameter no greater than the outer diameter of the gastric tube, so that the gastric tube is retained in an uncompressed condition in the gastric tube opening in the gastric tube retainer.